NPI age
20 years
Enumerated 2005-07-28
● Active Type 2 · Organization
Jacks Pharmacy Inc
Jacks Pharmacy Inc is 1 of 397 pharmacy organizations in Idaho.
Primary specialty
Pharmacy
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Potter
Ceo
Last NPPES update
2026-03-02
Source: monthly bulk 2026-05
How this organization compares
Across 397 active pharmacy providers in Idaho.
NPI age
20 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
1
In the 70% of peers with subspecialties
NPI lifetime · 2005 → 2026
2005-07Enumerated in NPPES
2005
2026
Where they practice
Primary practice location
103 E College Ave
St Maries, ID 838612247
Mailing address
103 E College Ave
St Maries, ID 838612247
Authorized official
Benjamin Ralph Potter
Ceo
📞 2087199095
Individual providers at this organization
3 individual providers on file at this primary practice address.
- Jeffrey Bash, PHARM-D Pharmacist NPI 1023617883
- Di Ann Butterfield, PHARMD Pharmacist NPI 1396225827
- Brook Kotlarz, PHARMD Pharmacist NPI 1124718051
Specialties
-
Pharmacy PrimaryA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the...
-
Durable Medical Equipment & Medical SuppliesA supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002494400 | |
| 05 (ID) | 002494500 | |
| 01 (ID) | 1303483 | NCPDP |
Practice context
Multi-provider organization. 3 individual providers on file at this primary address.
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Request a quote →How to verify this organization
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.